The when and how of second opinions

Unhappy with your doctor's suggestions? Here's what you should do when struggling with a decision related to second opinion

2 stethoscopes
At least once in life, we all come across a health situation involving us or someone close to us, in which the first treatment fails to bring relief. At such times, though we trust our primary physician [who is often our family doctor], we start to worry that she might not be able to solve our problem. It is at this point that we are tempted to consult another doctor for a second opinion.

The dilemma

Second opinions can work both ways—they can be of tremendous help or they could add to the confusion and worsen our situation. Take the case of Mahesh, who was suffering from fever for 10 days. His family physician had given him the usual course of medicines and had recommended all the standard tests. The results turned out negative. However, Mahesh’s fever persisted even after completing a course of antibiotics. Mahesh decided to take a second opinion. He went ahead and consulted a senior physician, known for his diagnostic skills, knowledge and experience.

The senior doctor went through Mahesh’s reports and ordered a battery of tests. When the results came negative, the doctor advised him to go for more extensive tests. Now, Mahesh was in a quandary—he didn’t know whether he should trust his family physician’s original diagnosis or spend plenty of time, energy and money on the additional tests suggested by the senior physician? Unfortunately, this question cannot be answered easily. It needs a third doctor to be called in who will then help Mahesh choose between the two options in front of him. The biggest problem with second opinions is when they are in conflict with the first opinion.

Should you or shouldn’t you?

So does that mean one shouldn’t seek a second opinion? One should, but only after sufficient amount of time and reasonable trial of medicines has been given by the primary doctor. Running to another doctor too early or too late in the disease can harm the patient. While most family physicians know the patient’s systems and choose a particular course of treatment based on that, a doctor who is consulted for the first time goes purely by the reports. The physician who has known the patient for some time, often for several years, is willing to take a few calculated risks or chances, while an unknown physician will go for a ‘no risk’ or a ‘defensive’ approach. Patients invest many years in developing a trust for their physicians and are prone to trust their family doctors more than second opinions.

When should you seek a second opinion?

Seek an opinion only when there seems to be no response even after a reasonable amount of time has passed and all the basic treatment has been tried. Second opinions should be sought purely for medical reasons, and not because the patient is worried or scared.

Whom to believe?

A common error many patients make is to seek a second opinion, and then choose the option that is convenient to them. For example, if the family doctor tells them to wait and watch, but the senior doctor advises immediate surgery, a majority of patients go by the convenient option of waiting instead of surgery. Depending on what the patient is suffering from, their convenient decision could have positive or negative results. Correctness rather than convenience should be the criteria for following or ignoring a second opinion.

How do you decide what’s correct?

If both opinions are contradictory, as it often happens, the only way out is to take a third opinion. There is no way for the patient to know which doctor is correct as these are highly technical areas where vast medical knowledge and experience is required to know the right from the wrong. This then becomes much like a legal situation where two parties are fighting and arbitration can only be brought about by a third party or by a judge.

How to go about a second opinion?

When a second opinion is sought, the patient should write down a summary of her case in her own words and carry it with her to the consultation. This helps avoid repetition, confusion and saves the time that is spent on updating the doctor on the case. The patient should also carry all reports along with the list of medicines consumed in the past, and a list of all the medicines she is allergic to, so that the new doctor is aware of what to avoid prescribing.

Second opinions are usually sought from doctors who are senior and have a vast experience. Such doctors are hard-pressed for time, so it is better to stick to the facts when speaking to them and not to go into what the patients feels about the disease. You should listen carefully to what they are saying as, often, in your anxiety or worry, you miss out on what the doctor says, which results in misunderstandings. Unlike your primary physician, it may not be possible to repeatedly call the senior physician to clarify your doubts again and again, which is where listening attentively helps.

Should you share the initial diagnosis?

A lot of people are scared that if they share their doctor’s diagnosis with the new doctor, it might colour the second expert’s opinions. Not telling is a bigger risk.

If she does not know what is the initial diagnosis and treatment, she might unnecessarily repeat the same treatment, not knowing that they have been tried and have failed. It is better to be a hundred per cent honest and open.

Should you tell your doctor?

Patients often hide the fact that they are seeking a second opinion from their doctors fearing that it looks like lack of trust. But that depends a lot on the kind of person the doctor is. Most good physicians know their limitations and themselves suggest a second opinion. But it is always better that your doctor knows the truth. In case, after consulting another expert, some emergency arises and the new expert is not reachable, it is your family doctor who can help you.

Should the family doctor suggest?

Ideally, your doctor should suggest whom to approach for a second opinion simply because she knows all the experts in the area. She also knows from past experience who is good and who isn’t. As a patient, you might not be able to come to a decision on choosing an expert by asking your friends or relatives as each person’s experience with a doctor is different. Again, if the family doctor refers you to a specialist, you have to trust your doctor and the expert she recommends.

Second opinions are required in many cases, but the onus is on the primary doctor and on the patient to trust each other. If you have chosen your family doctor correctly and trust her, just go ahead and do what she says. Mistrusting everyone is not helpful.

P V Vaidyanathan
Dr P V Vaidyanathan, MD, DCH, is a Mumbai-based paediatrician in private practice, hobbyist writer, and author of a book on childhood stress management.


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